DeAnza College/CIS2/Summer 2011/Group 5

A computer-generated image of HIV exiting a cell. Source: AVERT.org

Every day 33.4 million people are fighting a war. There are no guns, and there are no bombs, but there is death. They are fighting a disease that attacks their own bodies. This sickness wipes out a person's internal defenses, causing them an onslaught of opportunistic infections. This disease is known as the Human Immunodeficiency Virus, otherwise known as HIV. Not only can this virus cause a multitude of infections and illnesses, but it is capable of causing a silent but deadly killer, Acquired Immunodeficiency Syndrome, or AIDS. There is no peace treaty that can be signed to end this atrocious pandemic, no means to an end, but the battle can be contained.

General Information about HIV/AIDS

HIV

• H – Human – This particular virus can only infect human beings.
• I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you.
• V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

Human Immunodeficiency Virus is a lot like other viruses, including those that cause the common cold. But there is an important difference – over time the immune system can clear most viruses out of your body. This isn't the case with HIV – the human immune system cannot clear from the body. It is still unknown why this happens. HIV can be dormant for a long period of time in the body. When it becomes active, it attacks a key part the immune system – the T-cells and the CD4 cells. The body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself and then destroys them. Over time, HIV can destroy so many of the CD4 cells that the immune system can't fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS.

AIDS

• A – Acquired – AIDS is not something that is inherited. AIDS is acquired after birth
• I – Immuno – The immune system include all the organs and cells that work to fight off infection or disease.
• D – Deficiency –AIDS is contracted when the immune system is "deficient," or isn't working the way it should.
• S – Syndrome – A syndrome is a collection of symptoms and signs of disease.

AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infection(OI). The AIDS diagnosis is given if there is one or more specific OIs, certain cancers or a very low number of CD4 cells

Origin of HIV Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. They believe that the chimpanzee version of the immunodeficiency virus (called simian immunodeficiency virus or SIV) most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and came into contact with their infected blood. Over decades, the virus slowly spread across Africa and later into other parts of the world. Recent studies indicate that HIV may have jumped from monkeys to humans as far back as the late 1800s.

Watch HIV Replication 3D Medical Animation 5 minute video. (Courtesy, YouTube).

How HIV is Spread

HIV is spread primarily by:
•All unprotected sex with someone who has HIV contains some risk.
      ° Unprotected anal sex is riskier than unprotected vaginal sex.
      ° Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex.
• Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex. Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex.
• Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection.
• Being born to an infected mother—HIV can be passed from mother to child during pregnancy, birth, or breast-feeding.

Less common modes of transmission include:
• Being "stuck" with an HIV-contaminated needle or other sharp object. This risk pertains mainly to healthcare workers.
• Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk is extremely remote due to the rigorous testing of the U.S. blood supply and donated organs/tissue.

HIV cannot reproduce outside the human body. It is not spread by:
• Air or water.
• Insects, including mosquitoes.

Saliva, tears, or sweat. There is no documented case of HIV being transmitted by spitting.
• Casual contact like shaking hands or sharing dishes.
• Closed-mouth or “social” kissing.

Stages and Variations of HIV Disease

Signs and Symptoms of HIV: As early as 2-4 weeks after exposure to HIV (but up to 3 months later), people can experience an acute illness, often described as “the worst flu ever.” This is called acute retroviral syndrome (ARS), or primary HIV infection, and it’s the body’s natural response to HIV infection. During primary HIV infection, there are higher levels of virus circulating in the blood, which means that people can more easily transmit the virus to others.

Signs and Symptoms

Signs and Symptoms of HIV can include:

• Fever and Chills
• Rash
• Night sweats
• Muscle aches
• Sore throat
• Fatigue
• Swollen lymph nodes
• Ulcers in the mouth

When HIV infection progresses to AIDS, many people begin to suffer from the following symptoms:

• Fatigue
• Diarrhea
• Nausea and Vomiting
• Fever, Chills, and Night Sweats
• Wasting syndrome at late stages.

Diagnosis

HIV test looks for signs of HIV in the body. The most common type of testing is a blood test but there are other kinds of HIV tests that use urine or an oral swab. Some tests take a few days for results, but rapid HIV tests can give results in about 20 minutes. The test time can vary from person to person because of the time difference of the body to produce the antibodies that will be detected by the test.

HIV Numbers and Facts

Worldwide Map of HIV/AIDS Prevalence

No Data Less than 0.1% 0.1 - 0.5% 0.5 - 1% 1 - 5% 5 - 15% 5 - 50%

U.S. Statistics

• More than one million people are living with HIV in the U.S.
• One in five living with HIV is unaware of their infection.
• Men who have sex with men of all races remain the group most severely affected by HIV.
• By race, African Americans face the most severe HIV burden.
Source: http://AIDS.gov

Global Statistics

• 33.4 million are currently living with HIV/AIDS.
• More than 25 million people have died of AIDS worldwide since the first cases were reported in 1981.
• In 2008, 2 million people died due to HIV/AIDS, and another 2.7 million were newly infected.
• While cases have been reported in all regions of the world, almost all those living with HIV (97%) reside in low- and middle-income countries, particularly in sub-Saharan Africa.
• More than 67 percent (approximately 22.4 million people) of those infected are in sub-Saharan Africa
• In Asia an estimated 4.7 million people were living with HIV in 2008, including the 350,000 people who became newly infected.
• In Latin America there were an estimated 2 million people living with HIV/AIDS in 2008

• In Eastern Europe and Central Asia there were 1.5 million people living with HIV/AIDS

Source: http://AIDS.gov

Combating HIV/AIDS

Prevention Methods

Millennium Development Goals page dedicated to HIV/ADS of United Nations website, provides a detailed report on what has been done to contain the spread of the disease.

Effective Strategies and Accomplishments

In certain countries like Botswana, offering free access to antiretroviral has helped increase the life expectancy of those who suffer with HIV/AIDS.

Knowledge and education about safe sex has also helped in slowing new infections in young people.

Other programs such as The 100% Condom Program, in Thailand "enforce[s] 100% condom use at every commercial sex encounter in the country". Because "the primary axis of HIV transmission in Thailand was from commercial sex worker to men, from men to their wives, and from wives to their children, it was thought that reducing the risk of HIV transmission in commercial sex would be an effective means of slowing the spread of the HIV epidemic."

Less Effective Initiatives

Antiretroviral, although it has helped in gaining life expectancy and has not only gained recognition and expanded into lower income communities is not being developed fast enough, and HIV infection rates are outpacing it.

Another issue is that some of the education, on how to prevent the contraction of the disease, is not clear enough to be understood. Such as the ABC approach:
• A = abstain
• B = be faithful
• C = condomise

Though it worked as a slogan in an awareness campaign, it didn't "define the circumstances under which the component parts of A, B and C would be promoted and whom they would be promoted to."

Cure and Treatment of HIV/AIDS

There is no a cure for HIV/AIDS, however the modern treatments prolong an infected person's life for many years.

Present Treatment Options

There are treatments such as taking antiretroviral drugs. Sometimes even two or more different kinds at once.

List of approved and available drugs that can be taken:
• Combivir
• Kaletra
• Epzicom (in USA)
• Kivexa (in Europe)
• Truvada
• Atripla

Additionally, the following drugs will be available in generic form in the next 6 months:
• didanosine (ddI) delayed release capsules
• zidovudine, AZT, azidothymidine, ZDV (100 mg capsule)

Full list of US FDA approved antiretroviral drugs.

Human trials of pre-exposure prophylaxis: “In November of 2010 results from a Phase III large-scale study, iPrEx, showed pre-exposure prophylaxis, provided an additional 44 percent protection from HIV acquisition. The study enrolled 2,499 men who have sex with men and transgender women who have sex with men (who were all at high risk of HIV infection), from Peru, Ecuador, South Africa, Brazil, Thailand and the United States. Half the study subjects were given once-daily oral FTC-TDF (emtricitabine and tenofovir disoproxil fumarate), brand name Truvada, and the other half were given a placebo. All subjects received monthly HIV testing and risk-reduction counseling. Among those taking FTC-TDF, 36 became infected with HIV during the trial, compared to 64 in the placebo group. The protective effect was even higher among those with good pill adherence."

Research for Cure

Gene Therapy: Researchers in America have successfully created immune cells that are resistant to HIV. "T-cells, which are the main target of HIV, were isolated from six HIV positive patients and genetically manipulated to confer resistance. The cells were then injected back into the patients and were able to survive and multiply." Though the results of the phase I clinical trial did not provide a cure, they suggest gene therapy may be a viable treatment in the future. BioNews provides detailed information on the research: Potential breakthrough in HIV gene therapy.

Living with HIV/AIDS

Today, it is possible to live a fulfilling, productive life after being diagnosed with HIV and AIDS. By making healthy lifestyle choices and following these guidelines, HIV and AIDS patients will feel better physically and emotionally.

• Eat a well balanced diet and exercise regularly.
• Nutritious food can work with medications to help boost weakened immune systems:
    ° The correct foods can ease side effects of HIV/AIDS medications.
    ° It is important to prepare food carefully to prevent any bacterial infection.
    ° Have a daily exercise routine such as yoga or walking.
• Find a HIV specialist to manage the medications and monitor the immune system.
• Condom use is an absolute must
• Understand opportunistic infections and how to prevent them
    ° Fungal infections
    ° Bacterial infections
    ° Viral infections
    ° Parasitic infections
• Know everything about HIV medications
• Keep track of lab results
    ° CD4, (T-cells) counts
• Join a support group

Support for HIV/AIDS people

Global Organizations

United Nations

The United Nations supported HIV/AIDS through WHO, World Health Organization, and UNAIDS. WHO has a HIV/AIDS Department in Geneva, Switzerland. Every two years, WHO attends a conference hold by AIS and Italian National Institute of Health. The conference discusses about the pathogenesis, treatment and prevention of HIV/AIDS. UNAIDS is a Joint United Nations Programme on HIV/AIDS that focuses on achieving universal access to prevention, treatment, care and support of HIV/AIDS . UNAIDS fulfills its mission by:
• Uniting the efforts of the United Nations system, civil society, national governments, the private sector, global institutions and people living with and most affected by HIV.
• Speaking out in solidarity with the people most affected by HIV in defense of human dignity, human rights and gender equality.
• Mobilizing political, technical, scientific and financial resources and holding ourselves and others accountable for results.
• Empowering agents of change with strategic information and evidence to influence and ensure that resources are targeted where they deliver the greatest impact and bring about a prevention revolution.
• Supporting inclusive country leadership for sustainable responses that are integral to and integrated with national health and development efforts..

Red Cross

IFRC, International Federation of Red Cross and Red Crescent Societies, is a global alliance in which national Red Cross and Red Crescent Societies joint together. One of their goal is to fight HIV/AIDS by reaching out to people with its HIV programme in prevention, treatment, care and support. The American Red Cross have also worked with several Red Cross and Red Crescent national society around the world in their international HIV/AIDS programs. Several countries that have been working together with American Red Cross to support HIV/AIDS are Haiti, Guyana, Tanzania, Russia, Vietnam, Kenya and Honduras.

World AIDS Campaign

This world wide organization was build but UNAIDS to focus on annual communication, education, and prevention of AIDS throughout the world. One of the event that this organization is responsible of is the World AIDS Day which is observed on December 1. This day is dedicated to raise HIV/AIDS awareness and to hold memorial for people who died from AIDS around the world. Each year the World’s AIDS Campaign's Global Steering Committee establishes a theme for the World AIDS Day and runs campaigns around the world.

Community Organizations

San Francisco AIDS Foundation

This California foundation is dedicated to provide resources for people who are struggling with HIV/AIDS. San Francisco AIDS Foundation .has three commitments which are:
• Reducing HIV infections: Devising new prevention tools and relying on proven scientific research and community knowledge, the foundation is committed to dramatically reducing new HIV infections.
• Encouraging HIV testing: The foundation provides HIV testing and STI screening to meet the demand among the most vulnerable communities and advocates for new technologies and testing protocols that target those at greatest risk. Through legislative advocacy, we are eliminating barriers that restrict or complicate the availability of HIV testing services.
• Improving health for people living with HIV: Housing and medical referral programs, counseling and treatment for substance abuse, and weekly drop-in groups are closely connected to excellent client health. The foundation actively lobbies for universal access to health care and is determined to fight institutional obstacles and empower our clients and others to navigate the red tape that frustrates access to care and treatment.

L.A. Gay and Lesbian Center

This center serves for those who are infected by HIV since the earliest pandemic. In 1985 the L.A. Gay and Lesbian Center opened the first HIV testing site in California. It has several clinics for HIV victims with comprehensive free or low cost medical care, mental health therapy and on-site pharmacy which provide specialized drugs. Together with San Francisco AIDS Foundation, this center holds a fundraising event called AIDS/LifeCycle..LifeCycle is a bicycle riding event brought by San Francisco AIDS Foundation and L.A. Gay & Lesbian Center. Their mission is to raise awareness and knowledge about HIV/AIDS to their participants, donors, and public while raising funds to support the non-profit agencies. The biking takes seven days long to complete the route from San Francisco to Los Angeles.

AIDS Support Group in Cape Cod (ASGCC)

The mission of this support group is to provide services that maintain and enhance the quality of living with HIV/AIDS on Cape Cod and Martha’s Vineyard. and to provide health education, prevention and harm reduction outreach vie timely and accurate information about HIV/AIDS and other STD. This support group holds Annual Provincetown 5K Run/Walk Fundraiser to support their organization on helping people whose lives are affected by HIV/AIDS. This virtual running or walking is one of their event to reach $25,000 fund. Other fundraising events that it holds are Benefit Concert, Annual Silent Auction, Annual LIVE Art Auction, Annual Swim for Life and Paddler Flotilla, and Harbor to the Bay Boston to Provincetown Bike Ride.

Group 5 Point of View

There has been some progress in recent years in the fight against HIV and AIDS. The newest treatment was discussed at the 6th International AIDS Society conference on HIV Pathogenesis, Treatment and Prevention (Rome Conference) on July 17, 2011. There was an air of cautious optimism at the proceedings for the results from a promising study. This study relates to the possibilities of using HIV drugs as a preventative to new infection. This drug would be used as a pre-exposure prophylaxis against HIV and can reduce rates of HIV transmission to uninfected men who have sex with men.

The other promising treatments for HIV and AIDS are activating resting immune cells,gene therapy and new antiretroviral drugs. These are still in the experimental stages but studies indicate potentially positive results. Early sex education for the younger generation is perhaps the best prevention of the spread of HIV/AIDS.

In spite of these positive advancements, 7000 people everyday are infected with HIV. There are 9 million people in Africa (citing World Health Organization estimates) that meet the eligibility criteria for HIV treatment to commence yet lack access to lifesaving antiretroviral drugs. In the United States, despite the seriousness of the epidemic, there was not a comprehensive plan on AIDS until 2010. President Obama had promised to rectify this during his election campaign by committing to the creation of a National HIV/AIDS Strategy. The Strategy, which was launched in July 2010, is structured around three core aims: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related disparities and health inequities.

As a group, we would like to remain optimistic that HIV and AIDS can be cured in our lifetime. HIV and AIDS funding, research and education are necessary to achieve this goal.